Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh, India.
BACKGROUND
Weekly iron-folic acid supplementation in small-scale research trials and as administered in institutions has been demonstrated to be effective in reducing anemia in adolescent girls.


OBJECTIVE
To assess the effectiveness of weekly iron-folic acid supplementation in a large-scale project in reducing the prevalence of anemia in adolescent girls.


METHODS
The project provided weekly iron-folic acid tablets, family life education, and deworming tablets every 6 months to 150,700 adolescent school girls and non-schoolgirls of a total district population of 3,647,834. Consumption of the iron-folic acid tablets was supervised for schoolgirls but not for non-schoolgirls. Hemoglobin levels were assessed in a random sample of non-schoolgirls at 6 and 12 months and schoolgirls at 6 months. The effect of supplementation on the prevalence of anemia and the compliance rate were assessed over a 4-year period.


RESULTS
In 4 years, the overall prevalence of anemia was reduced from 73.3% to 25.4%. Hemoglobin levels and anemia prevalence were influenced significantly at 6 months. No difference in the impact on hemoglobin or anemia prevalence was observed between supervised and unsupervised girls. Counseling on the positive effects of regular weekly iron-folic acid intake contributed to a high compliance rate of over 85%. The cost of implementation was US$0.36 per beneficiary per year.


CONCLUSIONS
Weekly iron-folic acid supplementation combined with monthly education sessions and deworming every 6 months is cost-effective in reducing the prevalence of anemia in adolescent girls. Appropriate counseling, irrespective of supervision, is critical for achieving positive outcomes.
Vir
Sheila C
SC
Public Health Nutrition and Development Centre, New Delhi. sheila.vir@gmail.com
Singh
Neelam
N
Nigam
Arun K
AK
Jain
Ritu
R
D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000628:therapy; D003376:Counseling / Q000379:methods; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D005494:Folic Acid Deficiency / Q000097:blood / Q000188:drug therapy*; D006306:Health Surveys; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007194:India; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D009042:Motivation; D009752:Nutritional Status; D010349:Patient Compliance; D015995:Prevalence
D006454:Hemoglobins; D005492:Folic Acid; D007501:Iron